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Influenza Surveillance

Severe Acute Respiratory Infection Surveillance (SARI)
Rationale Severe acute respiratory infections (SARI) can be the result of several agents: viral, bacterial, and parasites, even though bacterial and parasitic agents can be less common. Among the viruses, influenza viruses are among the major causes of SARI.
Any preventive or control measure related to Influenza requires the availability of surveillance, including the seasonality pattern and the causative agents.
SARI surveillance in Lebanon was established in collaboration of the World Health Organization.
Objectives The objectives of Severe Acute Respiratory Infection (SARI) in Lebanon are:
- To estimate morbidity (incidence) of SARI in Lebanon
- To identify baseline figures and alert/outbreak thresholds
- To describe SARI cases by time, place, person, susceptibility, severity
- To identify circulating influenza strains and detect novel viruses
- To contribute to the global influenza surveillance
Sources of data Data sources are hospital sentinel sites. Sentinel surveillance focuses on collection of data from specific pre-selected health sites to carefully monitor a specific disease. The collection of the data is systemic. The sites are selected based on key criteria: willingness, activity and representativeness of the population.
The current sentinel sites are:
- In the mohafazas of Beirut and Mount Lebanon: Rafik Hariri University Governmental Hospital (RHUH), American University of Beirut Medical Center, Quarantina Governmental Hospital
- In the mohafazas of Bekaa and Baalbeck/Hermel: Baalbeck Governmental Hospital
- In the mohafazas of North and Akkar: Kheir Hospital
Case Definition An acute respiratory infection with:
- History of fever or measured fever of >=38°C and cough
- Onset within the last 10 days
- Requiring hospitalization
Case Investigation For each SARI case, data is collected including demographical and clinical data. Also, clinical specimens are collected for laboratory testing. The needed specimens are: nasopharyngeal swab (preferable one), oropharyngeal swab, bronchoalveolar lavage (if done), or tracheal aspirate (if patient intubated).
Laboratory Testing Laboratory testing for SARI patients are performed at the National Influenza Center at RHUH. The laboratory testing includes RT-PCR for Influenza viruses A and B.
SARI forms - Laboratory request form
Results - Latest weekly bulletin
- Latest weekly severity indicators
- Link to WHO database
 
Intensive Care Unit Based Surveillance (ICU)
Objectives The main objectives of ICU-based surveillance are to:
 - Measure and monitor on weekly basis morbidity indicators related to severe acute respiratory infections in Lebanon
 - Detect abnormal pattern and novel agents at an early stage, and investigate them
 - Assist decision makers on proper control measures
Data sources Data sources are both ICUs in public and private hospitals across Lebanon. The MOPH decision requested each hospital to designate a focal person from the ICU medical staff in charge of reporting to the MOPH.
Case definition - Severe Acute Respiratory Infection with fever and dyspnea
- Whatever was the etiological agent
- Admitted to ICU
Data collection Data is collected using a specific form. The form is sent every week by the hospital event if no cases were reported. The reporting form is a nominative line-listing.
Guidelines ICU-based surveillance for acute respiratory infection: Ar, En, Fr
Weekly form - ICU weekly reporting form
Results - Latest weekly summary
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ATC Name B/G Ingredients Dosage Form Price
N02BE01 TYLENOL B Paracetamol - 100mg 100mg Suppository 190,826 L.L
N02BE01 TYLENOL B Paracetamol - 200mg 200mg Suppository 235,172 L.L
N03AF01 TEGRETOL B Carbamazepine - 2% 2% Suspension 456,906 L.L
N07XX02 TEGLUTIK G Riluzole - 5mg/ml 5mg/ml Suspension 9,574,189 L.L
N03AF01 TEGRETOL B Carbamazepine - 2% 2% Suspension L.L
R05CA12 TOUCALM G Dried Ivy leaf extract - 0.7g/100ml 0.7g/100ml Syrup 300,765 L.L
R06AD08 TOPLEXIL B Oxomemazine HCl - 0.33mg/ml 0.33mg/ml Syrup 615,480 L.L
N03AX18 TREPADIO G Lacosamide - 10mg/ml 10mg/ml Syrup 948,753 L.L
R05DB13 TUSSIN G Butamirate citrate - 7.5mg/5ml 7.5mg/5ml Syrup, sugar free 296,925 L.L
R05DB13 TUSSIN G Butamirate citrate - 7.5mg/5ml 7.5mg/5ml Syrup, sugar free 154,862 L.L
H03BB02 TAPAZOLE B Methimazole (Thiamazole) - 5mg 5mg Tablet 565,694 L.L
C09AA03 TENSIKEY G Lisinopril - 5mg 5mg Tablet 456,906 L.L
C09AA03 TENSIKEY G Lisinopril - 20mg 20mg Tablet 460,938 L.L
C09AA05 TRITACE B Ramipril - 2.5mg 2.5mg Tablet 263,393 L.L
C09AA05 TRITACE B Ramipril - 5mg 5mg Tablet 509,316 L.L
C09AA05 TRITACE B Ramipril - 10mg 10mg Tablet 689,391 L.L
M03BB52 TRANCODEX G Paracetamol - 450mg, Chlormezanone - 100mg Tablet 99,828 L.L
C09BA03 TENSIKEY COMPLEX G Lisinopril - 20mg, Hydrochlorothiazide - 12.5mg Tablet 536,193 L.L
C09BA05 TRILTEC PLUS G Ramipril - 10mg, Hydrochlorothiazide - 12.5mg Tablet 2,243,577 L.L
C09BA05 TRILTEC PLUS G Ramipril - 5mg, Hydrochlorothiazide - 12.5mg Tablet 2,189,823 L.L
G04BE03 TOURNES G Sildenafil - 50mg 50mg Tablet 994,259 L.L
J05AR12 TELADINE G Lamivudine - 300mg, Tenofovir disoproxil fumarate - 300mg Tablet 17,454,739 L.L
G04BE03 TOURNES G Sildenafil - 100mg 100mg Tablet 1,592,310 L.L
L02BA01 TAMOXIFENE BIOGARAN G Tamoxifen (citrate) - 10mg 10mg Tablet 415,247 L.L
L04AA31 TERAGIO G Teriflunomide - 14mg 14mg Tablet L.L
L02BA01 TAMOXIFENE BIOGARAN G Tamoxifen (citrate) - 20mg 20mg Tablet 858,715 L.L
C09CA07 TELMICARD 40 G Telmisartan - 40mg 40mg Tablet 659,123 L.L
C09CA07 TOLURA G Telmisartan - 40mg 40mg Tablet 532,162 L.L
C09CA07 TELMICARD 80 G Telmisartan - 80mg 80mg Tablet 865,179 L.L
C09CA07 TOLURA G Telmisartan - 80mg 80mg Tablet 698,798 L.L
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